Provider Demographics
NPI:1942992920
Name:SUPERIOR TREATMENT AND RELIABLE SERVICES
Entity type:Organization
Organization Name:SUPERIOR TREATMENT AND RELIABLE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANICA
Authorized Official - Middle Name:EDRIRE JOI
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-947-7535
Mailing Address - Street 1:5107 W WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-5020
Mailing Address - Country:US
Mailing Address - Phone:773-947-7535
Mailing Address - Fax:773-947-2882
Practice Address - Street 1:7531 S STONY ISLAND AVE STE 152
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3954
Practice Address - Country:US
Practice Address - Phone:773-947-7535
Practice Address - Fax:773-947-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care